Environmental Disease

: 2022  |  Volume : 7  |  Issue : 1  |  Page : 16--21

Awareness of health and environmental hazards of plastic bag use and available substitutes among health workers of two hospitals in a rural area of Northwest Nigeria

Adewale Olufemi Ashimi1, Taiwo Gboluwaga Amole2, Abdulkadir Yusuf1, Godpower Chinedu Michael3,  
1 Department of Obstetrics and Gynaecology, Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria
2 Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria

Correspondence Address:
Godpower Chinedu Michael
Department of Family Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano


Objective: This study assessed health-care workers' awareness of the health and environmental hazards associated with plastic bags and available substitutes. Methods: This cross-sectional questionnaire-based survey was carried out in two rural hospitals in Northwest Nigeria over a 4-week study period. It included permanently employed health workers who were residents in the study community. The data were analyzed using SPSS version-20; the association between respondents' sociodemographic characteristics and awareness of the harmful effects of plastic-bags was determined using the Chi-square test. Results: There were 200 respondents aged 20–55 years with a mean of 31.7 ± 8.6 years. Most, 45% (90/200), respondents were nurses/midwives; 21% (42/200) were doctors. Most respondents, 49% (98/200), would throw away the plastic bags after a single use; 23.5% (47/200) would keep and reuse, while 45.5% (91/200) use reusable bags for shopping. Most respondents, 91% (182/200), were aware of the harmful effect on the environment, while 74% (148/200) knew it could be harmful to health. Respondents' age (>30 years) was significantly associated with awareness of the harmful effects of used plastic bags (P = 0.03), while male gender, age >30 years, being married, and of non-Hausa/Fulani ethnicity were associated with awareness of plastic-bag substitutes. Conclusions: Most respondents were aware of the health and environmental hazards of plastic bags and the available substitutes. Promoting reuse of plastic bags and the use of available substitutes will help to control this growing hazard.

How to cite this article:
Ashimi AO, Amole TG, Yusuf A, Michael GC. Awareness of health and environmental hazards of plastic bag use and available substitutes among health workers of two hospitals in a rural area of Northwest Nigeria.Environ Dis 2022;7:16-21

How to cite this URL:
Ashimi AO, Amole TG, Yusuf A, Michael GC. Awareness of health and environmental hazards of plastic bag use and available substitutes among health workers of two hospitals in a rural area of Northwest Nigeria. Environ Dis [serial online] 2022 [cited 2022 Jun 28 ];7:16-21
Available from: http://www.environmentmed.org/text.asp?2022/7/1/16/341190

Full Text


Modern-day plastic bags are found everywhere across the globe. People generally use them daily in numerous ways; these include the disposal of waste, storage of food items, and shopping. They are often preferred to other bags and packaging materials because of their lightweight, resistance to natural degradation (by sunlight, bacteria, chemicals), waterproof, and, most importantly, cheaper than other alternatives (e.g., paper bags).[1],[2]

Nevertheless, plastic bags have become a subject of concern in recent times because they are not biodegradable, often for single use, last for many years (500–1,000 years)[3] and have potential negative consequences on the environment. The impact of these bags on the environment is huge; the waste generated from them can be enormous and are often improperly managed and end up littering the streets and environment. Even where they are appropriately disposed of, they can still be washed by rain or blown by storm into rivers, oceans, or other water bodies, ultimately affecting marine life.[2],[4] Furthermore, reports have shown that they can block sewage and drainage systems, resulting in flooding.[5],[6]

In addition, they are known to accumulate water that serves as potential breeding grounds for the mosquito that transmits infections such as malaria; malaria is a disease of public health concern that is associated with significant morbidity and mortality.[5] They are also harmful to animals that inadvertently ingest them by blocking their digestive tract.[5],[6] For instance, cows have been reported to suffer from feeding impairment resulting in malnutrition; seabirds, sea turtles, and fishes have also been noted to ingest plastic bags as they resemble their prey.[6],[7],[8],[9],[10] Besides these, plastic bags are known not to decompose; instead, they photodegrade by splitting into several toxic pieces, contaminating water bodies and the soil, consequently endangering plant and animal flora.[1],[5]

To address this problem, governments of different countries have considered several approaches that include modifying the consumers' behavior toward the use of plastic bags through the introduction of charges and a ban on its production while encouraging recycling.[11] Although recycling is a waste management approach and a logical way of reducing the demand for new plastic bags, this option seems unpopular, especially in our settings.[12]

The imposition of plastic bag taxes is widely used. It is valuable in generating revenue and encourages the re-usage of the bags instead of throwing them away after a single use, thus reducing the quantity of plastic bags in circulation. This approach is used by several European countries such as Denmark and Ireland.[13] Furthermore, some African countries such as Tunisia and Zimbabwe have gone ahead to ban some categories of plastic bags, in addition to the introduction of taxes for other types of plastic bags. Other countries such as Benin, Cameroon, and South Africa have banned the use of plastic bags, which will ultimately reduce the quantity of plastic waste and limit the consequences on the environment.[5],[14] Nigeria, the most populous country in Africa, is planning to join the league of countries that have banned the use of plastic bags, and the bill has been passed by the Nigerian Federal House of Representatives.[15] According to the bill, anyone found guilty and convicted of the offence shall be fined up to five hundred thousand naira (USD $1,000) or imprisonment not exceeding 3 years or both. The bill further states that the retailer shall offer the customer plastic bags at the point of sales, and it will be an offense if paper bags are not provided.

Paper bags are a widely recognized substitute for plastic bags, among other notable substitutes like bags made from cotton and jute.[3],[4] These substitutes are biodegradable, recyclable, reusable, and environmentally friendly. Moreover, many of them can withstand more pressure than plastic bags. They are also produced in different colors and sizes; hence, they can be adapted to several situations.[4]

Due to their training, it is widely believed that health-care workers should be aware of potential environmental and health implications associated with the use of plastic bags and are presumed to be in a better position to highlight the demerit(s) of plastic bags and suggest alternatives, especially in rural communities. To our knowledge, there are no studies on the awareness of the health and environmental effects in this part of the country, especially among health-care workers. The health-care workers in this study constitute the majority of the government employees residing in this community; hence, they would often be relied upon for information and guidance on hazards posed by the use of plastic bags and the available substitutes, should the proposed bill be passed into law. Hence, this study sought to assess the awareness of health-care workers in this rural community about the health and environmental hazards associated with plastic bags and the available substitutes. The findings from this study would be relevant in planning strategies toward improving the awareness of hospital workers on hazards related to plastic bags and promoting the use of available substitutes in the community.


Study area and population

This study was carried out among health-care workers of Federal Medical Centre Birnin Kudu and the General Hospital Birnin Kudu over 4 weeks from October 17, 2019, to November 14, 2019. The two health facilities are in Birnin Kudu Local Government Area of Jigawa State, Northwest Nigeria. Jigawa State shares a boundary with Kano State in the Southwest; Yobe, Northeast; Katsina, Northwest; and Bauchi State in the Southeast. Birnin Kudu is also a local government area headquarters in the state. According to the 2006 population census, it had 314,108 inhabitants and a projected population of 419,800 in 2016.[16] Its inhabitants are predominantly Muslims and of the Hausa/Fulani ethnic group. Their major occupation is farming. Birnin Kudu is about 60 km southeast of the state capital.

The Federal Medical Centre is a tertiary health facility funded by the Federal government of Nigeria. It caters for the health-care needs of the people in the town and the border towns in Kano, Bauchi, and Yobe states. Furthermore, it serves as a referral center to all the neighboring primary and secondary health facilities within and outside the state. The hospital is a 250-bedded facility, and it offers general and specialist services. The different cadres of health-care workers in the facility include nurses/midwives, resident doctors, and consultants in various specialties, laboratory scientists, pharmacists, and physiotherapists. The Birnin Kudu General Hospital is a secondary health facility owned and solely supported by the state government. It is a 180-bedded facility and provides free maternity care services, including drugs, to all pregnant women and children under 5 years of age. The health-care workers available in the facility include nurses/midwives, resident doctors, and technicians in the laboratory, pharmacy, and dental unit.

The study population consisted of health-care workers of the two hospitals who were permanently employed and resided in the community. Health-care workers on annual or maternity leave and those that did not accept to participate were excluded.

Study design and sample size

This study adopted a cross-sectional design. An estimated sample size of 181 was obtained using Fisher's formula for calculating sample size in health studies,[17] and the following item measures were used: 95% confidence level, an estimated level of 86.4% awareness of health hazards regarding plastic bags in Mangalore India,[2] and a 5% margin of error. The computed sample size was inflated by 20% to account for anticipated subject nonresponse; hence, the minimum sample size was 222. Probability proportionate to size was used in allocating the sample size to the two health facilities based on the total number of health-care workers in each facility.

Study instrument and data collection

A structured self-administered questionnaire adapted from a similar study was used in this study.[2] It was pretested for the sensitivity of the questions, comprehensibility, and appropriateness of language. The instrument included questions on sociodemographic characteristics of respondents, awareness of the environmental and health hazards of plastic bags, and known substitutes for plastic bags. The questionnaire was in English and was administered to 222 health-care workers after obtaining consent. This study was carried out using a multi-stage sampling procedure. The first stage was the stratification into five professional groups (doctors, nurses, pharmacists, laboratory scientists, and others, including the physiotherapists and radiographers). The second stage of stratification was by seniority. Doctors were stratified into consultants and residents; the nurses were stratified into matrons and staff nurses; the physiotherapists were stratified into those above the rank of senior physiotherapist and those below; pharmacy workers were stratified into pharmacists and pharmacy technicians; the laboratory workers were stratified into laboratory scientist and laboratory technicians; while the dental workers were categorized as dental technicians. The third stage was by simple random sampling from each substratum from the list of these professionals obtained from each health facility.

Ethical consideration

The participants were assured of confidentiality and that nonparticipation in the study would not in any way affect them. The questionnaires were anonymized to preserve participants' identities, and they were free to opt out of the study at any time if they so wished. Written informed consent was obtained from respondents that agreed to participate. Ethical clearance was sought and obtained from the Ethics and Research Committee of the study site that was a tertiary hospital.

Data analysis

Data obtained were analyzed using Statistical Pack for the Social Sciences-version 21 (International Business Machines Corporation, Armonk, NY, USA). The categorical variables were summarized using frequencies and percentages, while means and standard deviation were used to summarize the quantitative variables. The Chi-square test was used to determine the association between the categorical variables. P < 0.05 was considered statistically significant.


Two hundred and twenty-two questionnaires were administered; 200 were returned completed by the respondents giving a response rate of 90.1%. One hundred and forty-two (71%) were from the tertiary health facility, while 58 (29%) were from the secondary health facility.

Sociodemographic characteristics of the respondents

The respondents' ages ranged between 20 and 55 years with a mean of 31.7 ± 8.6 years. More than half (n = 113; 56.5%) were females, married (113; 56.5%), and a few were divorced (3; 1.5%) [Table 1]. All the 200 respondents had one form of tertiary education. Slightly over half (n = 109, 54.5%) were of Hausa ethnicity, and a majority (n = 177, 88.5%) were Muslims. Nearly half (n = 90, 45%) were nurses/midwives, while nearly a quarter (n = 42, 21.0%) were medical practitioners.{Table 1}

Participants' responses to questions concerning awareness of the health and environmental hazards of plastic bags

Among the respondents, 98 (49.0%) would throw away plastic bags after a single use, 47 (23.5%) would keep and reuse them, while 91 (45.5%) would use a reusable bag for shopping [Table 2]. One hundred and eighty-two (91%) were aware of the harmful effects of plastic bags to the environment, of which blockage of the drainage pathway (n = 122; 67%), littering the environment (n = 51; 28.1%), and environmental pollution (n = 9; 4.9%) were mentioned. Of the 148 (74.0%) respondents who thought that discarded plastic bags could be harmful to health, 80 (54.1%) thought of them as sources of contamination, 50 (33.8%) felt they facilitated the transmission of infections, while 18 (5.4%) thought they were associated with water-borne diseases.{Table 2}

Association between respondents' awareness of harmful effects of plastic bags and sociodemographic characteristics

Only the age of the respondents (≥30 years) had a statistically significant association with being aware of the harmful effects of used plastic bags (P = 0.03) [Table 3].{Table 3}

Association between respondents' awareness of substitutes for plastic bags and sociodemographic characteristics

Among the respondents, 38 (19.0%) were not aware of any substitute for plastic bags, while 162 (81.0%) mentioned substitutes which included raffia bags (n = 107; 53.5%), paper bags (n = 106; 53.0%), bags made from cotton (n = 41; 20.5%); and 14 (7.0%) felt leather bags were also substitutes. The respondents' age, ethnicity, gender, and marital status were significantly associated with being aware of the substitute for plastic bags, as shown in [Table 4] with P < 0.05.{Table 4}


The use of plastic bags for daily routine activities has come under scrutiny today because of its potential effect on the health and environment. Interestingly, despite the high awareness level regarding the health hazards of plastic bags, about half of the respondents discard their plastic bags after their first use and slightly below half have used reusable bags. This suggests that there may be other compelling reason(s) for this disconnect between the display of the knowledge and attitude toward the use of plastic bags by the respondents. These reasons may include its availability, ease of use, and cost-effectiveness.[2],[4],[5],[18] In addition, about a quarter of respondents were unaware of the health hazards associated with its use, and about 10% were unaware of its environmental consequences. These findings are remarkable since the respondents are regarded as role models and advocates of health promotion in the community. Their perception and attitude toward plastic bags are crucial in rural communities where little or no information may be available to the residents concerning hazards and consequences associated with plastic bags.

It is also important to mention that despite the high level of awareness of plastic bag substitutes among the respondents, one-fifth of them were ignorant of any plastic bag substitute at a time Nigerian citizens may need to use plastic bag substitute(s) if the bill is signed into law by the President. Interestingly, the young unmarried female respondents of Hausa/Fulani ethnicity were not likely to be aware of available substitutes for plastic bags. This finding may be attributed to a decrease in demand for plastic bags by this group of women because they typically have reduced daily activities like shopping that warrants its use compared to married women.

Furthermore, the proportion of respondents aware of plastic bags' health hazards was high (74%). However, this finding is comparable to the proportion of respondents from Mangalore (86.4%) reported by Joseph et al. in India.[2] In addition, the 91.0% awareness of the environmental impact by our study respondents is similar to the 88.7% reported by Negussie and Mustefa in Eastern Ethiopia.[19]

Furthermore, only 23.5% of respondents always reused their plastic bags; this finding is similar to the 20% reported in Mangalore, India. This low proportion may be attributed to the fact that reusing plastic bags may be unhygienic, as 8% of reused bags have been reported to harbor pathogenic organisms such as Escherichia coli.[20]

The paper bags that the Nigerian Federal Government is currently promoting as one of the plastic bag substitutes were mentioned by 53.0% of our study respondents as a substitute. However, this proportion is much lower than the 84.7% reported in eastern Ethiopia by Negussie and Mustefa.[19]

Limitation of the study

Although this study involved a secondary and tertiary health center in a rural area of northern Nigeria, it did not involve primary health care facilities in the area, and as such, it may not be an accurate representation of health-care workers working in this rural community. In addition, recall bias in completing the questionnaires cannot be eliminated. Furthermore, 22 (9.9%) nonresponders may differ from the participants. Nevertheless, helpful information concerning the usage of plastic bags and available substitutes among health-care workers in a rural community in Northwest Nigeria was generated.


The majority of the respondents were aware of the health and environmental hazards associated with plastic bags as well as the available substitutes but are often not used. Promoting re-use of the bags as well as the use of available substitutes (such as paper bags) through mass education campaigns will help to control this growing hazard.

Therefore, the professional bodies of these health-care workers could evolve strategies to educate their members, while the enlightenment of policymakers on the need for public sensitization is also necessary. Future studies could explore the perception and knowledge of residents in the community about the imminent ban of plastic bags and their uptake of plastic-bag substitutes.


We thank the secretariat staff of the Department of Obstetrics and Gynecology, Federal Medical Centre Birnin Kudu, Nigeria, for their support.

Financial support and sponsorship

The authors funded the study.

Conflicts of interest

There are no conflicts of interest.


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